Is Omicron the Great Barrington variant?
Omicron may be the variant that ends the pandemic--or not.
On October 4, 2020, three epidemiologists and economists authored the Great Barrington Declaration (GBD). Their assertion was that the lockdowns, social distancing and other mitigation techniques to control the COVID-19 pandemic inflicted too high a price on the physical and mental health of the population. The central tenet of the GBD was that “focused protection” of the most vulnerable could be imposed, and that COVID-19 would pass through the rest of the population without significant consequence, leading to “herd immunity”. While some embraced the Declaration, many infectious disease specialists, myself included, thought the advice was, shall we say, unwise.
Sweden did try a variation of the GBD “focused protection”, but found that there was no benefit to the economy, and they had MORE mortality than their Scandinavian neighbors. Many of us felt the GBD and Swedish models made some very unrealistic assumptions about the ability to separate the most vulnerable (aged, immunocompromised, obese and other high risk conditions) from the general population. Additionally, in October, 2020, we could see that the vaccines in development looked promising, and that the Trump Administration’s Operation Warp Speed would deliver meaningful amounts of vaccine in short order. We worried that just “letting it rip” would lead to wide scale transmission, unmanageable surges of cases, and that “focused protection” is something that sounds good in abstract, but does not reflect reality.
Now, 14 months after GBD, vaccines have been widely available in the United States and Western Europe, but cases are still surging as ever more transmissible variants of SARS-CoV-2 emerge and spread across the globe. But this may be the moment for the GBD folks to really show if it works.
In many, if not most, areas of the United States, lockdowns and mask wearing are not implemented, even if recommended. As for “focused protection”—it’s really not happening from with respect to institutional controls (exception—public transport, hospitals), but we do have pharmaceutical interventions—vaccines, monoclonal antibodies (when available), direct acting antivirals (coming soon) and even some early proven treatments (possibly fluvoxamine) that can protect the most vulnerable and mitigate early disease. Of course, this assumes they can be distributed and that people will take them—which is the same sort of possibly unrealistic assumptions that sank GBD “focused protection” to begin with. The GBD “focused protection” might work in an island nation like New Zealand or Australia, or a totalitarian dictatorship like the People’s Republic of China. In a free society, some will balk at being protected or protecting others, as we have seen with wearing masks and using vaccines.
Why will Omicron be different than Delta, Alpha and the original (“wild type”) strains that came before?
Omicron is much more infectious than Delta—on a level approaching measles regarding transmissibility.
Omicron has mutations that allow it to evade previous immunity. The first two monoclonal antibody preparations from Eli Lilly and Regeneron are useless against it. Previous vaccination holds up well IF fully vaccinated and boosted, but only insofar as preventing severe disease. I am hearing numerous first hand reports of people who have recovered+vaccinated+boosted coming down with COVID-19 over the last few weeks—presumably the Omicron variant which is now dominant
Several studies indicate it causes milder disease in laboratory settings. Some studies have shown the overall rate of hospitalization from Omicron is less, but whether this is due to less damage from the virus, or that immunity from previous vaccination or recovery from infection is the primary driver is still unclear.
Recently, CDC shortened quarantine times after exposure, and isolation times after infection, for cases of COVID-19—down to about 5 days if there are no symptoms, or symptoms resolved. After these recommendations were released, there was great debate as to whether this reflected science—or the concerns of industry that 10 to 14 days of quarantine/isolation would grind vital services to a halt. My guess: both played a role in the decision. Chances are great that absent mask mandates, Omicron will spread swiftly.
So will Omicron end the pandemic? My marker of the end of the pandemic is this: surgeons can schedule elective cases for patients that require hospitalizations, and emergency rooms are no longer boarding patients for days on end waiting for hospital beds. Just walking around without a mask, attending unmasked indoor events, or eating in restaurants, is not a sign the pandemic is over, especially if you can’t get needed medical care because hospitals are overrun with COVID-19 patients—which is where we are at right now.
Omicron may spread quickly and widely enough, that at some point, almost everyone will have been exposed. The question is: at that point, will you have been protected by enough doses of vaccine and/or previous infection, so that exposure becomes a nonevent.
Because I don’t know how many vaccine exposures are needed, and I spend a great time working with immunocompromised patients, I will continue to be cautious. I will not seek out Omicron to “get it over with.” I will still wear a mask in public spaces, because wearing a mask is a form of community service—you are protecting those around you who may have immunocompromised status, or live with someone who does.
As German Health Minister Jens Spahn remarked, before this pandemic ends, “everyone will be vaccinated, recovered or dead.”
Until then, the pandemic continues.